Attorney in Houston, TX

In-House

Houston, TX

Attorney in Houston, TX

Non-practicing Attorney

Min 5 yrs required

No

Claims Medicare and Regulatory Compliance Specialist
The candidate will lead the development and implementation of quality/compliance/legal assessments and/or manages compliance activities to ensure effective oversight of operational risk. Brief senior leadership on results, trends, studies, and initiatives. Recommend process improvements and escalate existing and emerging risks associated to business processes. Act as a trusted advisor for the business and mentors' peers. Oversee accurate and timely Section 111 reporting for Medicare, including capturing and submitting data related to claimants' Medicare eligibility, total payment obligations to claimants (TPOCs), and ongoing responsibility for medicals (ORM). Collaborate with claims teams to identify gaps in claimant eligibility data and implement processes to ensure accurate reporting to the Centers for Medicare & Medicaid Services (CMS), minimizing potential penalties and compliance risks. Develop and maintain robust workflows for CMS reporting, including validation of data submissions, resolution of errors, and ensuring compliance with updates to CMS Section 111 guidelines and thresholds.